| Objective To observe the characteristics distribution of histiocytic necrotizing lymphadenitis(HNL).To explore the efficacy of optimal TCM comprehensive diagnosis and treatment scheme in HNL and develop the optimal therapeutic scheme.Methods HNL inpatients(186 cases)were collleted,and statistical analysis was performed.186 cases of HNL were randomized into a treatment group and a control group,with 93 cases in each group.Patients in control group were treated with TCM comprehensive diagnosis and treatment scheme.Patients in treatment group were treated with optimal TCM comprehensive diagnosis and treatment scheme.Both groups were treated for 2 weeks.Before and after treatment,the both groups of clinical cure rate,time to clinical response(TTCR),time to pain disappearance,body temperature normalization time,accompanying symptom disappearance rate,TCM syndrome score,lymphadenectasis degree,pain visual analogue scale(VAS),body temperature,lymphadenectasis reduction rate,adverse reaction,abnormal laboratory indexes[white blood cell(WBC),C-reaction protein(CRP),erythrocyte sedimentation rate(ESR),alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),inducible protein-10(IP-10),Fas ligand(FasL),monokine induced by interferon-y(Mig)]normalization rate were compared.Results(1)Epidemiological Characteristics:186 cases of histiocytic necrotizing lymphadenitis were collleted,who were treated in the Nanjing integrated traditional Chinese and western medicine Hospital Affiliated to Nanjing University of Chinese Medicine,covering 14 provinces,municipalities and autonomous regions of mainland China.HNL is found predominantly in patients about 30 years of age,with average age is(30.30±11.28)years old,with a higher ratio of females to males affected(male vs female 1:3.04).All together,100%of our patients presented with lymphadenopathy,72.58%with unilateral cervical lymph node enlargement,90.32%with pain,65.52%with fever,37.10%with aversion to cold,34.41%with thirst,32.26%with inappetence,30.11%with constipation,31.18%with headache,26.34%with dysphoria,23.66%with perspiration,13.44%with rash,12.90%with pharyngalgia,12.37%with cough,11.83%with rhinobyon.The most common laboratory findings were elevated ESR(53.23%),leukopenia(44.62%),elevated CRP(34.41%),elevated FasL(26.88%),elevated AST(24.73%),elevated IP-10(23.12%),elevated Mig(22.04%),elevated ALT(20.97%)and elevated LDH(19.35%).(2)The distribution characteristics of TCM syndromes:43.01%of patients in treatment group with wind-heat phlegm-toxin syndrome,44.09%with heat-toxin obstruction syndrome and 12.90%with phlegm-blood stasis syndrome.(3)The overall effect:All together,100%of our patients presented with lymphadenectasis reduction rate,89.78%with the clinical cure rate,83.19%with accompanying symptom disappearance rate,average TTCR(10.95±4.31)days,average time to pain disappearance(3.76±2.25)days,average body temperature normalization time(0.99±0.93)days,average TCM syndrome score(11.18±9.74)score,average lymphadenectasis degree(2.64±0.70)cm,average VAS(3.41±1.97)score,average body temperature(37.59± 1.00)℃.There were no significant differences in mean age,number of patients,gender,course of disease,TCM syndrome score,lymphadenectasis degree,VAS,body temperature,adverse reaction,WBC,CRP,ESR,ALT,AST,LDH,IP-10,FasL,Mig prior treatment between the two group(P>0.05).Compared to before treatment,the lymphadenectasis degree,VAS,body temperature,adverse reaction and TCM syndrome score of the two groups after treatment were improved(P<0.01).The clinical cure rate,accompanying symptom disappearance rate,TTCR,lymphadenectasis degree and VAS of the treatment group were better than the control group[90.23%vs 79.57%,90.48%vs 75.00%,(10.17±3.95)vs(11.72±4.54),(0.12±0.40)vs(0.30±0.62),(0.06±0.29)vs(0.22±0.55)](P<0.05).But there were no statistical difference compared with time to pain disappearance,body temperature normalization time,TCM syndrome score,body temperature,lymphadenectasis reduction rate and adverse reaction between the two groups(P>0.05).(4)The effect of wind-heat phlegm-toxin syndrome:Compared to before treatment,the lymphadenectasis degree,VAS,body temperature,and TCM syndrome score of the two groups about wind-heat phlegm-toxin syndrome after treatment were improved(P<0.01).The clinical cure rate,TTCR and lymphadenectasis degree of the treatment group were better than the control group[100%vs 86.79%,(8.03±2.16)vs(10.89±4.85),(0.0310.16)vs(0.20±0.52)](P<0.05).But there were no statistical difference compared with time to pain disappearance,body temperature normalization time,TCM syndrome score,body temperature,VAS,accompanying symptom disappearance rate,lymphadenectasis reduction rate and adverse reaction between the two groups(P>0.05).(5)The effect of heat-toxin obstruction syndrome:Compared to before treatment,the lymphadenectasis degree,VAS,body temperature,and TCM syndrome score of the two groups about heat-toxin obstruction syndrome after treatment were improved(P<0.01).The TTCR,body temperature normalization time,lymphadenectasis degree,VAS and accompanying symptom disappearance rate of the treatment group were better than the control group[(10.83±3.69)vs(12.80 ± 3.69),(1.41±0.63)vs(2.00±0.78),(0.07±0.30)vs(0.43±0.73),(0.15±0.42)vs(0.63±1.10),94.74%vs 71.05%](P<0.05).But there were no statistical difference compared with clinical cure rate,time to pain disappearance,TCM syndrome score,body temperature,lymphadenectasis reduction rate and adverse reaction between the two groups(P>0.05).(6)The abnormal laboratory indexes normalization rate:After treatment,Abnormal WBC,CRP,ESR,AST,ALT of the treatment group normalization rate were better than the control group[95.24%vs 73.17%,96.88%vs 81.25%,90.20%vs 72.92%,95.24%vs 72.00%,88.24%vs 59.09%](P<0.05).But there were no statistical difference compared with abnormal LDH,IP-10,Mig,FasL normalization rate between the two groups(P>0.05).Conclusion Compared with accompanying symptom aboard,a significantly higher incidence of histiocytic necrotizing lymphadenitis in mainland China.The optimal TCM comprehensive diagnosis and treatment scheme was far more effective than the TCM comprehensive diagnosis and treatment scheme,with obviously improving patients’ clinical cure rate,accompanying symptom disappearance rate,TTCR,lymphadenectasis degree,VAS and body temperature normalization time of heat-toxin obstruction syndrome.In addition,the optimal TCM comprehensive diagnosis and treatment scheme could normalize abnormal WBC,CRP,ESR,AST,ALT,effectively reduce the inflammatory effect,improve the two-way adjustment effect on the body’s immune system function,... |
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